Adolescent health care and the trainee: roles of self-efficacy, standardized patients, and an adolescent medicine rotation.

Purpose: Pediatric residents often cite a lack of confidence with adolescents owing to minimal exposure during training. Self-efficacy has been evaluated in a general context but not in relation to perception of knowledge and communication skill. Study objectives were to evaluate resident self-efficacy during a month-long adolescent rotation and to assess knowledge and communication skills in their relationship to self-efficacy.

Methods: Data were collected as part of the adolescent medicine rotation for pediatric residents at a local children's hospital. Residents completed 2 standardized patient cases at the beginning of the rotation and a self-efficacy instrument before/after the cases and at the end of the rotation. The study assessed trends in self-efficacy using repeated-measures analysis of variance and χ tests to examine relationships between self-efficacy and knowledge as well as communication in preventative and sexually transmitted infection adolescent health.

Results: Resident (n = 44) self-efficacy levels significantly changed over all time points and were significantly related to knowledge and communication levels. Although self-efficacy levels decreased immediately after the standardized patient cases, all self-efficacy items were significantly higher at the end of the rotation. Residents confident or very confident in general health topics were deficient in asking basic history items and residents confident or very confident in high-risk topics often did not actually assess these areas with patients.

Conclusions: Residents' personal assessments on paper may differ from actual clinical interactions. Standardized patient cases expose resident strengths and weaknesses with adolescents, and a month-long adolescent rotation allows for repetitive experiences with special adolescent health care topics with associated increase in self-efficacy, knowledge application, and communication skill.